It’s Friday!!!

Hello again Global Voice for Autism Friends,

It is the end of the week here in Jenin.  Its been a busy one for us.  Once we got past the locked door situation and the day without electricity…things began to get a lot better!!!  We spent Wednesday and Thursday taking several parents on community outings.  Everything went wonderfully.  I was so impressed with how well the children went along with our plans and behaved in the community.  The parents did an excellent job providing their children with social praise such as “Good Walking” and/or “Thank you for waiting quietly”.  They were patient and responded well to our requests and suggestions.  Our translators were a big help relaying anything that we wanted the parents to know throughout each outing!  Everything went smoothly.  It was awesome.

Today was a day of rest for us.  My teammates and I enjoy having a day to relax.  Sometimes we read or watch movies.  However, tomorrow starts another week for us.  Saturdays are always set aside for training days for parents.     Tomorrow parents will bring their children with them so that they can work on manding (requests) and tacting (identification) skills.  This is the time for the parents to practice the skills we have gone over in our trainings and seek our support for things have have questions about.  We are helping our parents learn strategies that are supported by many years of research and that we have used in the past with children.  Many of our parents have stated that their children exhibit “tantrum-like” behaviors when they do not receive what they want or need.  The strategies that we have been showing the parents build communication skills (manding) that the children will learn in order request wants and needs more appropriate ways.  Our parents also report that they would like to learn ways to teach their children new skills.  After manding, tacting is one of the next communication skills that are to come.  Our strategies for helping parents teach this skill involve positive reinforcement and practice.

There are additional skills that are critical to helping children who have developmental delays.  Manding and tacting just name a few.  As our time here with the families continues we will also visit other ABA strategies used with children with autism.  Stay tuned for more.

submitted by Katrina Walker

Language v. Communication

Google Translate opens up the world. Yesterday morning I tried to ask the secretary of the center a question in Arabic, but could not convey what I wanted to ask. The moment reminded me of many I experienced with my Syrian friends in Jordan. In these moments we have so much to say but lack the words with which to say it, so we rely on a mechanized service to provide us with these words. I opened Google Translate on the secretary’s computer to ask my question and before I knew it an hour had passed. In that hour we told stories, we shared our lives-past, present and future, and we did it all in silence, allowing a machine to produce the symbols that communicated words we could not yet speak.

Without a single vocalization, we were able to alleviate our communication barrier. Although the mothers in our program all dream of hearing their children’s voices, establishing a method of communication for each child is the first step to their success. Whether or not the mothers realize it, many have started to do this with their children. In her reflection on today’s community outing, Abed’s mother Hanaa noted that she pats Abed’s hair when she is happy with his behavior. While no words are exchanged through this gesture, she is still communicating to him that he has succeeded. When Abed jumps around in the toy store smiling, he is communicating his happiness even without words.

 

(Abed’s mother gives him the juice that was a gift from the shopkeeper at a store visit today)

Even in verbal interactions, the way that a message is communicated makes a difference in the way a child responds. On our community outing today we started by taking the children to the mall so that we could work on having them wait while their mothers shopped. When we transitioned to a store on a lower floor, Ahmad liked to jump down the stairs. His mother did not like this behavior, but when she told him “no,” he continued to jump. Instead, we coached her to tell him to walk with both feet and then to praise him for walking once he complied. Once she gave him the positive instructions, he listened and continued to walk down the stairs.

At the end of today’s outings, both mothers were happy with the way their children behaved in the community and were happy with the shopkeepers’ reception of their children. One shopkeeper even gave the children juice while their mothers shopped. With the realization that simple changes, such as telling a child what to do instead of what not to do can make such a significant difference, the mothers are feeling optimistic about their children’s behavior. By recognizing that communication can come in a variety of forms and finding the communication methods that work best for their own child, the mothers are able to understand and work with their children in new ways.

With this newfound understanding of the effect of their communication on their children’s behavior, the mothers will continue to practice reinforcing positive replacement behaviors in order to decrease the behaviors that they see as disruptive. As long as the positivity and reinforcement continues, the children are prepared to learn.

-Melissa

We’re in the news!

Read the article HERE!

Community Outings

Today’s objective was to take individual families out into the community to evaluate their child’s behavior in public, give feedback and advice to the parents, and to provide an opportunity for local businesses and community members to meet and interact with our families. The trips today were an overwhelming success.

Omar and his mother Naheel were first, and she explained one reoccurring behavior she wants to work on in the community setting is the length of time Omar will sit or occupy himself while she shops. We wanted to start the activity with a low demand, so we went to a toy store and had Naheel explain that we are going to shop for 15 minutes and if he behaves well then we would go out for a snack after. Omar explored the store and looked at items appropriately and responded perfectly when the owner of the store spoke to him and offered a free keychain.

(Omar shops with his mother at a toy, book and office supply store)

After 15 minutes we left and found a pastry shop where Omar picked out a snack and we sat down to eat. Once we were finished, Omar’s mother told him that we were going to do a little more shopping and he could pick out another snack that he can have if he does a good job waiting for her again. We walked to Alnimer Mall where his mother spent some time in a perfume shop and then a clothing shop. Omar was able to wait with his mother or sit in a chair until the time was up, and then we came back to the center to wait for Adnan and his mother Masa.

 

 

(Omar chooses a treat at the bakery as a reward for his good behavior)

Masa told us she has difficulty with Adnan yelling in toy stores and refusing to let go of things he wants. We wanted to begin in an environment where Adnan would easily succeed, so this time we started in some clothing stores and had Masa explain to Adnan that if he can wait and stay quiet while she shops then she will buy him a toy at the end of the outing. We had him wait for 5 minutes in the first store and then took a break, then tried and additional 5 minutes in another store. Adnan seemed to grow a little impatient toward the end but was appropriately expressing his desire for his mother to buy him a truck. We encouraged his mother to thank him for asking and for being patient but to then remind him how he is earning the toy by staying quiet and waiting. Adnan finished his time and even independently walked back over to his mother to wait when more shoppers came into the clothing store towards the end. When we finally got to the toy store it was clear that Adnan was very happy and he spent several minutes looking through the toy trucks. The store owner was very helpful in showing him different trucks he had and was very patient when Adnan changed his mind after purchasing a toy and let him pick out a different one. The shopkeeper even came out after we had left to give us a free Spiderman blow up doll!

 

(Masa praises Adnan for sitting quietly in the store while she shops)

 

(Masa asks Adnan his opinion about a shirt she likes)

 

(Adnan chooses a toy truck at the toy store at the end of our outing)

A few observations that our team will follow up with the parents on at the next meeting are remembering to not just say ‘Good job’ or ‘Thank you’ but also include what the child succeeded in doing. For example, ‘Good job waiting!’ or ‘Thank you for staying quiet’. We will also go over realistic expectations for what activities are acceptable while a child is waiting (for example, singing at a reasonable volume is typical behavior for children and should be tolerated if appropriate for the environment). And lastly, we will teach parents about setting up a schedule of verbal reinforcement so that the parents know when to engage with their children and can maximize the time they spend actually shopping.

Later this afternoon we met another family who was interested in signing up for our next round of trainings in March. It is encouraging to see more families seeking out services and being excited about participating in the cooperative here. Tomorrow we will have 3 more families coming for community outing activities.

-Daniel

A New Day in Jenin: Radio Interviews, Power Outages and Community Prep

Hello My Global Voice for Autism Friends,

I hope everyone who is taking the time to read this post is having a great day.  As for us in Jenin, I would say that the day has been very interesting.  It all started when last night when we returned home from a trip to see our friends and realized that we were locked out of our bedroom.  While we had our key, the lock for the door was broken and therefore, would not open.  After many tries and after removing the lock entirely, we were finally able to get into our room.  However, it became evident that the purchase of a new lock for our room door would be in our foreseeable future.

As we began to settle in for the night, leaving our fears of sleeping on the cold floor of the main room behind us, another situation occured.  As I settled in for bed listening to music on my laptop, the room went black.  My roommate, whose bed is diagonal from mine asked, “What just happened?”  I didn’t know.  As we came to the conclusion that power had gone out, we were lost for words.  She got out her flashlight, while I put away my computer and began listening to music on my iPod.  With no power, I decided that it was time to go to sleep.  Within minutes of this decision, thunder began to roll and rain began to fall. With the sound of the storm in the background, I began to drift off to sleep.

This morning I rose from bed and checked the lights in our room.  Still no power.  “Oh boy” I thought to myself, “today is going to be a great day!”  But in the end, everything worked out.

Recently, we returned from an interview at a local radio station called Radio Balad.  Through an interview on their station that is set to air Monday, we able to share information about our project and to tell more listeners living in the surrounding areas of Jenin about autism.

 

(Director Melissa Diamond answers questions about autism at our Radio Balad interview)

 

(The team at our radio interview)

Tomorrow we have community outings scheduled with some of the families in the program.  The mothers in the program have expressed that it is often difficult to carry out activities such as shopping with their children and that there is a need for more acceptance of autism in the community.  We will be accompanying each family into the community to work on ABA strategies that the mothers can use with their children when in public.  This will we be our first time doing community outings with the parents.  However, the parents are very excited to have a chance to learn ways to work on their children’s behavior when in the community.  We are excited as well.

submitted by Katrina Walker

Life is Wonderful (Happy Birthday Daniel!)

Every morning in Jenin I wake up so happy that I can’t believe that this is my reality. I am living across the world from home, with great friends and doing the work I love. I am acting on an idea developed in the back of a bus in May 2012 at a time when everything about this project seemed impossible. The process of getting here was not an easy one, but I truly believe that everything works out in the end. Life doesn’t always turn out as planned, but the best surprises can come out of what seem to be the worst possible situations. These challenges can deter us from our passions, or they can motivate us to work harder than ever before. Today, in the parent support group, it became clear that the mothers in our program are starting to see this as well. They say that they have hope for their children in a way that they have never had before, and for the first time they have the tools to get started on the process.

As happy as I am every morning, I am not always motivated to get out of bed to experience that morning cold that is still present in spite of the 70 degree weather. I have read more books for fun here than I have since high school, and some days I would be happy just reading–about autism, about history, about anything and everything, but today was Daniel’s 27th birthday and we had a surprise breakfast to make, so reading was not an option.

Daniel told us that he loves pancakes, something that we have not yet found in Jenin, so when we found a $8 box of pancake mix at the bakery yesterday we picked it up. In order to assure Daniel that he wasn’t getting TOO old, we made him a Mickey Mouse pancake and brought it to him in bed. (You’re never too old for Mickey Mouse!)

(Daniel’s Mickey Mouse Pancake with bananas, Nutella and coconut)

After breakfast, we prepared for today’s parent practice session. Since some of the families seemed overwhelmed by all of the toys available at the last practice session, we created a station for each family that had signed up for today’s session and set out a few preferred items for each child. This was this group’s first practice session and most of the families worked on manding and tacting exercises using picture cards, toys and puzzles. Both the parents and our therapist team felt that this session has been the most successful yet. One mother in our program noted that on past program days her son was reluctant to come and threw tantrums, but today he came willingly and was happy to arrive.

(Hanaa* works with son Abed* on a non-verbal manding exercise)

In addition to our regular families, we have a family who has been attending our trainings during their visit to Jenin from another city. Their son Omar* has strong manding and tacting skills but struggles with social interactions so today we taught his mother some activities he can do to strengthen his social skills and had him interact with his brother and the brother of another child in the program in a series of activities. The family plans to continue working on these activities at home and they will stay in touch with our team over email in order to learn new information and receive feedback on their work at home.

Social Skills:

(Omar and his brother take turns while playing a fishing game together)

(Omar plays catch with typically developing peers and sibling)

(Omar plays clapping game with therapist, mother, typically developing peers and sibling)

(Omar completes intraverbal conversation activity with a typically developing peer)

Support Group

The enthusiasm and commitment of the parents that we saw during the trainings today carried over into the support group. The mothers feel that they know what to work on with their children at home in the upcoming week and are excited for their community outings with the therapy team this week. On these outings, the mothers and their children will be accompanied in the Jenin community by a member of the therapist team and a translator. We will take the mothers and their children to local shops in order to work on behavior in public. Our team will get in touch with the businesses in advance and will ask them to be understanding when we bring children with special needs into their shops. Between the connections we have made in Jenin and Yousef’s vast network of connections in the community, we will not have a problem finding places that will welcome us for these outings.

Reflections from the Mothers:

“My son was excited to come to the program today, but he still cried when he was here. I was having trouble getting him engaged in activities but I learned some different ways to play with him from another mother in the session and these seemed to work better. I will continue to work with him at home using her methods.” -Hanaa*, mother of Abed*(5)

“Sometimes my son responded in the session today, but sometimes he did not. He is responsive when I do these activities at home so for now I am working on getting him comfortable [at the center] so that he can speak and ask for what he needs outside of my home.”-Tala*, mother of Myasar*(5)

“Academically, my son knows everything he needs to know and is able to go to school, but when I take him into the community, I know that people can still tell that he has autism. He doesn’t interact with anyone else around him. My goal is to teach him how to interact with others in the community and I was happy to get him working with some friends without autism today. I am very exciting for my community outing with the therapist team this Wednesday so that I can get feedback on how to work with him in public. I wouldn’t feel comfortable taking him out in my home community but since I don’t live in Jenin, I am comfortable with it here. I think that these outings are a great idea!”-Naheel*, mother of Omar*(9)

Birthday Celebrations

After we finished the session, we took a bus to our friends’ house in a nearby village for Daniel’s surprise birthday celebration. Our friends spent all night last night and all morning cooking and baking for the occasion and I have never seen such a feast in my life. They cooked a traditional Palestinian dish called Jaddara (rice and lentils) and made fresh salads with vegetables from their garden. Our friends’ mother baked fresh bread in an underground sand oven in their back yard. They made tea, followed by Arabic coffee, followed by cappuccinos.

We spent most of the afternoon relaxing in our friends’ living room, learning Arabic, playing card games, joking and listening to music. Another one of our favorite activities with our friends is Uno. Katrina brought Uno cards and this is another thing (in addition to the Mickey Mouse pancakes) that you can NEVER get too old for. The nine of us, ages 11-33, sat in a circle for much of the afternoon playing the card game, laughing and keeping score: wins for America v. wins for Palestine. America is ahead by one but our Uno Olympics are far from over!

When it was time for birthday cake, we had a second round to our feast. We bought a cake for Daniel yesterday and our friend baked one last night. She also baked one of her favorite recipes “Easy Cake” and made a traditional Palestinian dessert that she calls “Crazy” though I can’t imagine that we are hearing her correctly on that one. While Daniel was outside playing with turtles and watching the bread bake, my friends and I set up his birthday desserts and prepared his gifts. When he came in, we sang happy birthday and spent the rest of the evening celebrating. Before we knew it, it was 10p.m.

(Daniel’s birthday dessert feast: 2 birthday cakes, Easy Cake and Crazy)

(Happy 27th birthday Daniel!)

Recently, I have been asked many questions by friends back home about what life is like in Jenin and I can sum it up in three words: Ahlan wa Sahlan, Arabic for “Welcome.” Everywhere we go we are welcomed with warmth and enthusiasm. The friends we have had for a month feel like family and they treat us as through we truly are their brothers and sisters. With our friends, the language barrier feels irrelevant. Some things, like smiles and laughter and our abundance of birthday celebrations truly are universal.

Ahlan wa Sahlan. Welcome to Jenin.

-Melissa

New Friends

The plan for today was to visit the Arabic American University with Yousef and have a meeting with some of the faculty about our project. However, we discovered the appointment process is a little more rigid than we anticipated and had to reschedule this visit for another day. Instead we decided to attend an English class lecture at Al-Quds University with our friends and see the differences in teaching styles from American university lectures. Unfortunately, the professor had gone to Ramallah for the day and the lecture was canceled. SO… we moved on to plan C and just walked around town and got to know a new friend. Yesterday afternoon Yousef introduced us to another former volunteer at the center who is also studying Arabic at a university in Ramallah and she shared some of her experiences and gave us some great tips about other interesting places to visit in Palestine.

This evening the team went over plans for tomorrows therapy session. We were also reunited with Kitti via Skype and brainstormed about teaching strategies and reviewed some ABA procedures for practice. Tomorrow will be the first practice session for the second half of our families.

-Daniel

A Word From Our Mothers: Cooperative Therapy

Aseel* and her son Mohammad* and Fatima* and her son Basil* both participated in today’s cooperative therapy session. We divided the families into pairs and worked on manding, tacting and intraverbals. In their session, Aseel and Fatima also switched children to work on these skills. Here are their thoughts on the day:

Aseel & Mohammad

(Aseel works on removing Mohammad’s iPad in order to complete a manding activity)

What skills did you work on today?

Aseel: Mohammad loves his iPad and often refuses to let go of it to participate in other activities. Today, I practiced removing the iPad from him and getting him to answer questions and identify objects before getting it back. When I took it, he screamed and ran to the other side of the room but eventually I was able to bring him back to continue working. I also worked with picture cards and asked him to point to and label different foods and animals. When it was time to have the children fill in blanks in songs I started singing songs with Mohammad and then switched to singing to Basil. I noticed that Basil has trouble making eye contact and asked the therapists how we can help him do this.

What did you enjoy?

Aseel: I found today’s practice session interesting and useful. I liked having the chance to work with Basil and giving Mohammad the chance to work with Fatima. Even when Mohammad refuses to do activities he is still happy and shows he loves me. When I ask him too he will come over to kiss my cheek. I like when he listens to me.

(Aseel working on “intraverbal” song activities with Basil. Basil can’t speak yet, but he is developing his receptive language and eye contact skills.)

What was challenging?

Aseel: No matter what I did today, Mohammad did not want to stay seated in the chair. He kept running away to get out of having to do the activity. I think that this will be less of a problem at home because I can work on the skill in a place where he is comfortable. I hope that next week he will be more comfortable working here.

What did you think of the program?

Aseel: I liked the way the program ran today. I think that having the chance to apply the information from the trainings with the help of the therapists was important and having a smaller group was especially helpful in doing this. I am excited to practice these requesting skills at home so that I can come back last week and see that Mohammad has made progress. I feel ready to use these skills at home at different times of day. When I am cooking I can ask him to label foods and I can have him request his iPad and other toys he wants.

Fatima & Basil 

(Fatima helping Basil identify a horse out of the two choices pictured)

What skills did you work on today?

Fatima: Today I worked with Basil on picking the right object. My son can’t speak but when I tell him to point to the horse, sometimes he will listen to me. The therapists taught me about “errorless teaching.” This is where I guide Basil’s hand to the right object if he starts to reach for the other choice, before he can get the answer wrong. Aseel pointed out that Basil does not make eye contact with her when she works with him so the therapists also showed me some activities that I can do to help him develop that eye contact. I know this might be difficult for him because of his sensory challenges but in the support group I watched how I can do this by holding toys he likes near my face and getting him to look at them.

What did you enjoy?

Fatima: I love working with Basil and I feel successful every time he gets an answer right. Seeing his progress is encouraging. I also liked working with Mohammad on the songs. Aseel and I got to work together on the intraverbal songs with our sons which was fun. Basil can’t answer yet, but I think he likes the songs and I liked singing them with Mohammad because he could fill in the blanks.

What was challenging?

Fatima: I am still working on the concept of “errorless teaching.” It is my first instinct to say “no” when Basil reaches for the wrong object and I need to guide him instead. I am sure this will get easier by practicing at home. I also want to find ways to hold his attention and to get him to look at me.

What did you think of the program?

Fatima: I was happy to see how I can use the skills from the trainings at home. This became clear to me through the practice exercises today. I am going to practice each skill with Basil for 10 minutes each day throughout the week. This way, we can start on new skills when we come back next week. Having the chance to talk to the other mothers in the parent support group today was nice too. We talked about nutrition and medications. I have a new Omega vitamin that I want to try with Basil. Aseel told me that it works well.

-Melissa

Settling Back Into Jenin

Hello Global Voice for Autism Friends,

Wow! This has been a wonderful week.  I hope that everyone enjoyed looking at the pictures that our team has shared with you via the blog, Facebook, and etc.  We have traveled from the mountains of Jerusalem to the Mediterranean Sea.

Now that we are back in Jenin, it’s time to get back to work!  Tomorrow some of our families will come to the center for a hands-on run through of the cooperative component of the program.  We will have half our of families come tomorrow and the other half will come Monday.  Having a small group here will allow each mother-child pair to receive individualized attention.  The idea is for the parents to take the skills discussed in our didactic trainings and to apply them while working with the children in the program.

We will work on manding, tacting, and intraverbals.  These skills are the basis of  the development of verbal behavior for children with autism.  I have worked with many children in the past who have difficulty with these skills due their lack of or limitations in speech development.  Having limited speech or being non-verbal can lead some children on the spectrum to develop problem behaviors. These behaviors are an attempt to communicate in the only way that these children are able.  This is the situation with some of the children in our Jenin program.   By teaching parents to find ways to replace the behaviors with more appropriate ways of communicating we will  decrease the occurrence of these problem behaviors.  Once the parents in our program master this skill, they will be able to teach other parents in the community to do the same. We already have families interested in joining the next round of training (taught by the mothers) and two of these families will be visiting us during program hours tomorrow.

submitted by Katrina Walker

And…We’re Back!

This evening, we returned to Jenin after three action-packed days exploring Jerusalem.

It is hard to believe that three weeks have passed since the start of our program in Jenin. We are excited about the work we are doing and are looking forward to the next two months. Unfortunately, our three week milestone meant that today we had to say goodbye to team member Kitti Robinson as she prepares to return to her job in Virginia. Fortunately, Kitti will continue to participate in our work and will help us via Skype as we implement our program in Jenin. She even offered to Skype with us at 3a.m. her time on training days in order to be available for immediate questions during trainings. Now that is dedication! Since we did not have any trainings or lectures scheduled Tuesday-Friday this week, we decided to make a team event out of Kitti’s departure and spend a few days exploring Jerusalem. For those of you who have not seen this colorful and historically significant city, we have attached some pictures below. Enjoy! (PhotoCredit: Kitti Robinson)